Bin Yang, Xingguo Zhang, Hua Li, Decheng Wang
Department of Trauma Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Beijing, China; Beijing University of Chinese Medicine, China.
Department of Trauma Orthopedics, Traditional Chinese and Western Medicine Hospital in Tongzhou District, Beijing, China; Beijing University of Chinese Medicine, China.
J Orthop Sci. 2025 Feb 26. doi: 10.1016/j.jos.2025.02.004.
L-shaped incision is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative fracture malunion, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.
This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.
The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (P < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.
The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective minimally invasive treatment for Sanders type III-IV calcaneal fractures.
L形切口是治疗跟骨骨折最常用的方法；然而，它与各种并发症相关，如伤口感染、皮肤边缘坏死、术后骨折畸形愈合和创伤性关节炎。因此，这种手术方法应重新审视。本研究旨在探讨改良跗骨窦入路在Sanders III-IV型跟骨骨折切开复位内固定中的临床效果和安全性，并与传统L形入路进行比较。
本回顾性研究纳入了2018年5月至2020年6月期间采用改良跗骨窦入路（38例）和L形入路（34例）治疗的72例单侧闭合性Sanders III-IV型跟骨骨折患者。观察并比较两组患者术后并发症以及术前、术后3天和12个月时跟骨Böhler角、Gissane角和内翻角的变化。术后12个月，采用马里兰足部功能评分、美国足踝外科协会（AOFAS）评分和视觉模拟评分（VAS）评估两组足部功能恢复情况。
与L形入路组相比，改良跗骨窦入路组的切口愈合时间（9.8±1.9天）和手术时间（75.53±21.12分钟）明显更短，伤口愈合并发症也更少（2.6%）（P<0.05）。术后两组的Böhler角、Gissane角和内翻角无显著差异。术后12个月，马里兰、AOFAS和VAS评分无显著差异。
改良跗骨窦入路和L形入路在治疗Sanders III-IV型跟骨骨折方面具有相似的临床效果。然而，改良跗骨窦入路用于Sanders III-IV型跟骨骨折切开复位内固定时切口小、软组织损伤程度低、伤口愈合并发症少，从而为Sanders III-IV型跟骨骨折提供了一种有效的微创治疗方法。
